Healthcare Provider Details

I. General information

NPI: 1497692727
Provider Name (Legal Business Name): JEFFREY CHARLES SCHWARTZ NREMT-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 PAIUTE CIR
GRAND CANYON AZ
86023-1310
US

IV. Provider business mailing address

PO BOX 1652
GRAND CANYON AZ
86023-1652
US

V. Phone/Fax

Practice location:
  • Phone: 773-318-5171
  • Fax:
Mailing address:
  • Phone: 773-318-5171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License NumberA2005288
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: